Survey: Business owners want more health regulation

A new survey of small-business owners in 12 states, including Rhode Island, shows substantial support for government efforts to curb health care costs, including more regulation and a public alternative to the private insurance market.
The survey, sponsored by the Northwest Federation of Community Organizations and The Main Street Alliance and handled locally by Ocean State Action, asked 1,199 small-business owners about their experience with health insurance and their views on potential reforms.
Only one-third of respondents offered health coverage to their workers, while 43 percent were themselves covered through their business. Four in five of those offering coverage said it cost them at least 5 percent of payroll, while 41 percent said it cost more than 10 percent.
Almost three-quarters – 73 percent – said they were willing to pay to provide health care access to their workers, though generally less than actual reported costs. And among the self-employed, 61 percent said they’d like to be able to buy into a state or federal health care pool.
Most notably, given business owners’ historical opposition, for the most part, to expansions of government’s role in health insurance, the survey found that given a choice between a reform effort that adds a public coverage option, versus one that only expands private sector options, 57 percent of respondents chose the former, and 21 percent the latter.
Three-quarters of respondents also said they’d support more government oversight, and 70 percent said government should play a larger role in ensuring access to affordable health care.
“Small-business owners are willing to contribute to make the health care system work if they believe the system design makes sense, if financial responsibility is shared broadly and fairly, and if dollars are channeled toward providing needed care instead of third party profits,” the survey’s authors wrote.
Peter Asen, associate director of Ocean State Action, said the survey results, released last month, reflect small businesses’ sense that they, far more than large companies, are at the mercy of insurers, and that they need government’s help.
“People are unprepared for major rate increases that happen from year to year that are not predictable and they certainly can’t control the health of their own employees and how their employees use their health care,” Asen said. “More and more of them, I think, are just feeling the need to kind of opt out of it altogether or reduce what they’re able to offer to people.”
If small-business owners hadn’t struggled with the private system, Asen added, it’s possible that they’d resist government involvement, as business owners long have tended to do.
“But the frustration that people have had with the kind of nonsystem that we have now,” he said, “has led people to believe that it could be done better with the option of a government plan, and that there needs to be more government regulation of the way that the for-profit insurance industry operates.”
Notably, the Rhode Island respondents – 96 people – didn’t differ much in their views from their peers in other states, even though they were almost twice as likely to cover their workers – 61 percent, versus the national 34 percent – and/or get their own coverage through their business (86 percent versus 43 percent).
Rhode Islanders also pay more – 95 percent spent at least 5 percent of payroll costs on health insurance – and they have struggled for it: 43 percent of those with coverage had switched to plans with higher out-of-pocket costs, and 39 percent said they or their employees had delayed or avoided treatment because of health care or health insurance costs.
“I no longer have confidence that our current employer-based, private insurance system can be fixed,” said Ted Almon, president and CEO of the Claflin Co., in Cranston, and a survey respondent. Small businesses have lost confidence in the private market, he said, and “the consensus is growing that we need an alternative.”
In that sense, small and large businesses may be parting ways, Almon said, because small-business owners “kind of just want the monkey off their back when it comes to health care, and a public solution fits the bill.”
Lt. Gov. Elizabeth H. Roberts, a leading proponent of health care and insurance reforms in the state, said the survey results also reflect her sense of small-business concerns, and of the trend in public opinion across Rhode Island.
“They’re looking for answers, and affordable answers, and they want government involved in providing those answers,” she said. But there is a “mixed feeling,” especially among business owners, about the particular role that government should play.
“They are very supportive of some kind of blend, but I don’t think there’s a real consensus on what that blend should look like,” she said. “I do think many more are willing to consider a government alternative than you would’ve found several years ago.” &#8226